Provider Demographics
NPI:1508188293
Name:BORELLA-CLEMENTS, LORENA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:
Last Name:BORELLA-CLEMENTS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 856
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-0856
Mailing Address - Country:US
Mailing Address - Phone:530-859-5054
Mailing Address - Fax:
Practice Address - Street 1:419 CHESTNUT ST APT 2
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2918
Practice Address - Country:US
Practice Address - Phone:530-859-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist